Provider Demographics
NPI:1972552990
Name:GOLDEN STATE ORTHOPEDICS & SPINE
Entity Type:Organization
Organization Name:GOLDEN STATE ORTHOPEDICS & SPINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMARSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-939-8585
Mailing Address - Street 1:PO BOX 31396
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-8396
Mailing Address - Country:US
Mailing Address - Phone:925-939-8585
Mailing Address - Fax:925-933-2709
Practice Address - Street 1:2405 SHADELANDS DR
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2444
Practice Address - Country:US
Practice Address - Phone:925-939-8585
Practice Address - Fax:925-933-2709
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOLDEN STATE ORTHOPEDICS & SPINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-08
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6461930001OtherDME SUPPLIER PTAN
6461930001OtherDME SUPPLIER PTAN
CAZZZ29713ZMedicare ID - Type Unspecified
CAZZZ02417ZMedicare PIN
CAZZZ19827ZMedicare ID - Type Unspecified